DFW_1082.pdf
PDF 908 KB Posted
- Attached to
- RFQ 24-136 Fillmore Hatchery Trout Eggs
- Solicitation number
- 0000034633
- Issued by
- Ventura County, California
About this file
The document is a Bidder Declaration form (DFW 1082) issued by the State of California's Department of Fish and Wildlife, designed to capture information about prime bidders and potential subcontractors for a state contract. The form requires bidders to provide their California vendor name, current California certification numbers (such as Micro Business/Small Business/Disabled Veteran Business Enterprise), and details about any subcontractors they plan to use, including the subcontractors' names, contact information, addresses, certification numbers, specific work to be performed, and corresponding percentage of the bid price.
The form includes an example entry demonstrating how to complete the subcontractor information, with a sample subcontractor "Fix it Now" performing office repairs at 25% of the bid price. The document also requires the bidder to certify under penalty of perjury that all provided information is true and correct, with space for the authorizer's printed name, signature, and date. The form provides options to save, print, or clear the document, and appears to be part of California's procurement process for ensuring transparency and promoting diverse business participation in state contracts.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| std204.pdf | ||
| RFQ_24-136_Fillmore_Hatchery_Trout_Eggs.docx | DOCX document | |
| std1000.pdf | ||
| DFW_1080.pdf | ||
| std205.pdf | ||
| Recycled_Content_Certification.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
State of California – Department of Fish and Wildlife
BIDDER DECLARATION
DFW 1082 (REV. 09/30/21)
1. Prime bidder information:
a. What is your California vendor name?
b. Identify your current California Certification(s) number(s):
(MB/SB/DVBE):_____________ or None (If “None”, proceed to number 2)
c. Will subcontractors be used for this contract? YES NO (If yes, indicate in the space below the distinct element of work your business will perform in this contract. If no, skip to the certification at the bottom of this page.)
2. If subcontractors will be used, list all subcontractors for this contract in the table below. (Attach additional pages if necessary):
EXAMPLE
Subcontractor Name, Contact Person, Phone Number & Email
Fix it Now John Smith Jr.
(916) 445-1234
JSmithJr@fixitnow.com
Subcontractor complete address
1234 Fix It Pl.
Sacramento, CA
95821
CA Certification Number (MB, SB, DVBE, or None)
SB # 15245
Work performed or good provided for this contract
Office repairs
Corresponding % of bid price 25%
CERTIFICATION: By signing this form (Bidder Declaration), I certify under penalty of perjury that the information provided is true and correct.
Authorizers printed name: _______________________________________ Date: _______________
Authorizers signature: ____________________________________________
| Subcontractor Name, Contact Person, Phone Number & Email |
| Fix it Now |
| Authorizers Printed Name: |
| Date: |
| SAVE: |
| PRINT: |
| CLEAR: |
| What is your California vendor name: |
| MB SB DVBE: |
| None: Off |
| Will subcontractors be used for this contract Yes: Off |
| Will subcontractors be used for this contract No: Off |
| If yes indicate in the space below the distinct element of work your business will perform in this contract If no skip to the certification at the bottom of this page: |
| Subcontractor Name Contact Person Phone Number and Email: |
| 0: |
| Subcontractor Name Contact Person Phone Number and Email 1: |
| Subcontractor Name Contact Person Phone Number and Email 2: |
| Subcontractor Name, Contact Person, Phone Number and Email: |
| 3: |
| Subcontractor complete address: |
| 0: |
| 1: |
| 2: |
| 3: |
| CA Certification Number MB SB DVBE or None 0: |
| CA Certification Number MB SB DVBE or None 1: |
| CA Certification Number (MB, SB, DVBE, or None) 2: |
| CA Certification Number MB SB DVBE or None 3: |
| Work performed or good provided for this contract 0: |
| Work performed or good provided for this contract: |
| 1: |
| Work performed or good provided for this contract 2: |
| Work performed or good provided for this contract 3: |
| Corresponding percentage of bid price 0: |
| Corresponding percentage of bid price 2: |
| Corresponding percentage of bid price 1: |
| Corresponding percentage of bid price 3: |
File details come from the government source that posted it. Updated .